1
|
Lu Y, Zou Q, Jiang B, Li Q. Perioperative outcomes and safety of valveless insufflation system in minimally invasive urological surgery: a systematic review and meta-analysis. Int J Surg 2024; 110:5763-5770. [PMID: 38781046 PMCID: PMC11392197 DOI: 10.1097/js9.0000000000001634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND With the rapid development of laparoscopic and robot-assisted surgery, many technological innovations and improvements have emerged to optimize minimally invasive surgery and ensure minimal patient risk. Although AirSeal has been widely reported in the field of urology, its perioperative outcomes and safety in minimally invasive urological surgery remain unclear because of inconsistent levels of evidence. OBJECTIVES The authors performed this meta-analysis to evaluate the perioperative outcomes and safety of the valveless insufflation system (VIS) in minimally invasive urological surgery compared with the conventional insufflation system (CIS). METHODS The authors comprehensively searched PubMed, Web of Science, Cochrane Library, and Embase databases to identify eligible studies published up to January 2024. Review Manager software (version 5.3.0) was used for the statistical analysis. Eligible studies were randomized controlled trials (RCTs) or non-RCTs of minimally invasive urological surgery with VIS vs CIS. The study outcomes included perioperative outcomes and safety. The authors excluded publication types, including letters, reviews, case reports, and animal and pediatric studies. RESULTS The authors finally identified five RCTs and eight non-RCTs in this meta-analysis. The meta- analysis indicated that the operative time was comparable between the groups ( P =0.57, I2 =91%). However, a VIS may increase blood loss ( P =0.0004, I2 =45%) and shorten hospital stays ( P <0.00001, I2 =90%). Due to the high heterogeneity of the results, the authors carefully evaluated all included studies and discovered that the studies by Bucur and Ferroni may be the sources of heterogeneity. When these two studies were excluded, heterogeneity was significantly reduced, and the operative time for VIS was significantly shorter than that for CIS ( P =0.0002). Adjusted blood loss showed no difference between the VIS and CIS groups ( P =0.10). In terms of safety, the pooled results revealed that the incidence of Clavien-Dindo III-IV complications in the VIS group was significantly lower than that in the CIS group ( P =0.02, I2 =0%). Moreover, VIS significantly reduced general pain ( P =0.02, I2 =15%) and shoulder pain ( P =0.001, I2 =0%) 12-24 h postoperatively. No significant differences were observed in total complications ( P =0.06, I2 =0%), blood transfusion ( P =0.14, I2 =0%), and subcutaneous emphysema ( P =0.96, I2 =63%) between the two groups. CONCLUSIONS Our meta-analysis revealed additional perioperative advantages of the VIS in minimally invasive urological surgery. Moreover, VIS is superior to CIS owing to less severe complication rates, general pain, and shoulder pain.
Collapse
Affiliation(s)
- Youyi Lu
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
| | - Qingsong Zou
- Department of Urology, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai
| | - Bo Jiang
- Department of Urology, Qingdao Municipal Hospital, Qingdao University, Qingdao
| | - Qi Li
- Department of Endocrinology, Yantai Municipal Government Hospital, Yantai, Shandong, People's Republic of China
| |
Collapse
|
2
|
Manici M, Aykanat İC, Simsek D, Tarim K, Gurkan Y, Canda AE. Anesthesiological and surgical perspectives on using 8 mmHg versus 12 mmHg pneumoperitoneum pressures during robotic radical prostatectomy: Results of a prospective randomized study. ULUS TRAVMA ACIL CER 2024; 30:430-436. [PMID: 38863292 PMCID: PMC11230051 DOI: 10.14744/tjtes.2024.78617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Revised: 05/28/2024] [Accepted: 05/30/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND This study aims to compare the effects of 8 mmHg and 12 mmHg pneumoperitoneum (PNP) pressures on operative, postoperative, and anesthesiological parameters in robot-assisted laparoscopic radical prostatectomy (RARP). METHODS In this prospective study, 43 patients undergoing RARP performed by a single experienced surgeon were randomly assigned to either the low-pressure group (8 mmHg - Group I) or the standard-pressure group (12 mmHg - Group II). We evaluated the operative and postoperative parameters from both urological and anesthesiological perspectives. All patients were treated using the AirSeal® insufflation system. RESULTS No statistically significant differences were observed between the groups in terms of console time, estimated blood loss, time to first flatus, or hospital length of stay. PNP was increased due to bleeding in six patients in the 8 mmHg group and two patients in the 12 mmHg group. Except for the heart rate measured five minutes after the initial incision, there were no observed differences between the groups in terms of blood pressure, ventilation, and administered medications. The heart rate was significantly lower in Group I (54.4 vs. 68.8, p=0.006). Additionally, during the surgery, the number of manipulations performed by the anesthesiologists, including drug administrations and ventilator management, was significantly lower in Group I (6.1 vs. 9.6, p=0.041). CONCLUSION In RARP, while the 8 mmHg PNP pressure does not demonstrate differences in operative parameters compared to the 12 mmHg pressure, it offers the advantage of requiring fewer anesthetic interventions, thus minimizing the impact on cardiovascular and respiratory systems.
Collapse
Affiliation(s)
- Mete Manici
- Department of Anesthesiology, Koc University School of Medicine, Istanbul-Turkiye
| | | | - Doga Simsek
- Department of Anesthesiology, Koc University School of Medicine, Istanbul-Turkiye
| | - Kayhan Tarim
- Department of Urology, Koc University School of Medicine, Istanbul-Turkiye
| | - Yavuz Gurkan
- Department of Anesthesiology, Koc University School of Medicine, Istanbul-Turkiye
| | | |
Collapse
|
3
|
Yoshimatsu G, Sahara K, Ohno R, Kajitani R, Munechika T, Matsumoto Y, Nagano H, Watanabe T, Aisu N, Yoshida Y, Hasegawa S. Effect of heating insufflation tube of AirSeal system on laparoscopic surgery. Sci Rep 2024; 14:646. [PMID: 38182655 PMCID: PMC10770151 DOI: 10.1038/s41598-023-50321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 12/18/2023] [Indexed: 01/07/2024] Open
Abstract
The AirSeal system (CONMED, NY, USA) can outstandingly keep pneumoperitoneum stable. However, water droplets form on the access port, impairing the performance of comfortable surgical procedures because of the resultant wet surgical field. This study was performed to clarify the mechanism of water droplet formation and to prevent it. Condensation was observed on the AirSeal system. A heater was wrapped around the tri-lumen tube, and the heating effect was assessed. The simulator experiments revealed that condensation formed in the tri-lumen tube and on the wall of the access port. The accumulated weight of the condensation on the wall of the access port was 41.6 g in the Heated group, 138.2 g in the Control group, and 479.4 g in the Cooled group. In the clinical assessment, the accumulated volume of the condensation attached to the inside wall was significantly smaller in the Heated group than in the Unheated group (111.7 g vs. 332.9 g, respectively). We clarified that the volume of condensation attached to the wall of the access port depended on the temperature of the tri-lumen tube. The clinical study revealed that the condensation on the access port was reduced by heating the tri-lumen tube. The development of a novel heating device for the insufflation tube would be effective and useful.
Collapse
Affiliation(s)
- Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan.
- Department of Regenerative Medicine and Transplantation, Fukuoka University, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, Japan.
| | - Kurumi Sahara
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Taro Munechika
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Hideki Nagano
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Toshifumi Watanabe
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Yoichiro Yoshida
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-Ku, Fukuoka, 814-0180, Japan
| |
Collapse
|
4
|
Miao H, Zhang L, Jiang Y, Wan Y, Yuan L, Cheng W. Impact of surgical approach on progress of disease by type of histology in stage IA endometrial cancer: a matched-pair analysis. BMC Surg 2024; 24:9. [PMID: 38172752 PMCID: PMC10765681 DOI: 10.1186/s12893-023-02299-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND To compare the impact of surgical approach on progression free survival (PFS) stratified by histologic type in women diagnosed with stage IA endometrial cancer. METHODS Myometrial invasion is classified into no myometrial invasion, <50% and ≥50%, with only no myometrial invasion and <50% are included in stage IA patients. A retrospective study is designed by collecting data from women diagnosed as stage IA endometrial cancer from January 2010 to December 2019 in a tertiary hospital. A propensity score is conducted for 1:1 matching in the low-risk histologic patients. Progression free survival and disease-specific survival data are evaluated by the Kaplan-Meier method and compared by the log-rank test in both the whole population and the matched-pair groups. A sub-group analysis is performed to figure out risk factors associated with the effect of surgical approach on PFS and disease-specific survival (DSS). RESULTS 534 (84.49%) low-risk histologic endometrial cancer women, with 389 (72.85%) operated by minimally invasive surgery and 145 (27.15%) by open approach, and 98 (15.51%) high-risk histology, with 71 (72.45%) by laparoscopy and 27 (27.55%) by open surgery, are included. Compared to open surgery, laparoscopy results in lower progression free survival in low-risk patients before and after matching (p = 0.039 and p = 0.033, respectively), but shows no difference in high-risk patients (p = 0.519). Myometrial invasion is associated with lower progression free survival in laparoscopy in low-risk histology (p = 0.027). CONCLUSION Surgical approaches influence progression free survival in stage IA low-risk histologic diseases, especially in those with myometrial invasion, but not in high-risk histologic endometrial cancer.
Collapse
Affiliation(s)
- Huixian Miao
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lin Zhang
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yi Jiang
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Yicong Wan
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Lin Yuan
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China
| | - Wenjun Cheng
- Department of Gynecology, Jiangsu Province Hospital, the First Affiliated Hospital With Nanjing Medical University, No. 300 Guangzhou Road, Nanjing, 210029, Jiangsu, China.
| |
Collapse
|
5
|
Ayoub CH, Armache AK, El-Asmar JM, El-Achkar A, Abdulfattah S, Bidikian N, Abou Chawareb E, Hoyek E, El-Hajj A. The impact of AirSeal ® on complications and pain management during robotic-assisted radical prostatectomy: a single-tertiary center study. World J Urol 2023; 41:2685-2692. [PMID: 37704868 DOI: 10.1007/s00345-023-04573-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE We aimed to compare perioperative outcomes, post-operative complications, and opioid use between AirSeal® and non-AirSeal® robotic-assisted radical prostatectomy (RARP). METHODS We retrospectively collected data on 326 patients who underwent elective RARP at our institution either with or without AirSeal®. The first 60 cases were excluded accounting for the institutions' learning curve of RARP. Patient demographics, oncologic, pathologic, and surgical characteristics between AirSeal® and non-AirSeal® cases were compared. Furthermore, outcomes of interest including operative time, length of stay, morbidity, and opioid use for pain management were compared between the two groups. Univariate linear and logistic regression models were developed. RESULTS The AirSeal® group consisted of 125 (38.3%) patients while the non-AirSeal® group consisted of 201 (61.7%) patients. No statistically significant difference was seen in terms of patient demographics, oncologic characteristics, surgical characteristics, and pathologic characteristics between the two groups. In addition, univariate linear regression showed that RARP with AirSeal® displayed shorter operative times by 12.3 min and a shorter length of hospital stay by 0.5 days compared to the non-AirSeal® group (p < 0.001). Furthermore, the AirSeal® group witnessed lower odds of Clavien-Dindo (CVD) Class > 2 complications (OR = 0.102) and a lower need for opioid use (OR = 0.49) compared to the non-AirSeal® group (p < 0.022). CONCLUSION RARP using AirSeal® is associated with shorter operative times, shorter length of hospital stays, lower odds of CVD > 2 complications, and lower odds of opioid use with respect to non-AirSeal® RARP. The efficacy and cost effectiveness of using the AirSeal® system during RARP should be further studied and evaluated by clinical trials.
Collapse
Affiliation(s)
- Christian Habib Ayoub
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Alexandre K Armache
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Jose M El-Asmar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Adnan El-Achkar
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Suhaib Abdulfattah
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Nayda Bidikian
- American University of Beirut Medical School, American University of Beirut, Beirut, Lebanon
| | - Elia Abou Chawareb
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Elio Hoyek
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon
| | - Albert El-Hajj
- Division of Urology, Department of Surgery, American University of Beirut Medical Center, PO BOX: 11-0236, Riad El Solh, 1107 2020, Beirut, Lebanon.
| |
Collapse
|
6
|
Jiang Y, Wu Y, Lu S, Que Y, Chi Y, Liu Q. Patients with low body mass index are more likely to develop shoulder pain after laparoscopy. Acta Obstet Gynecol Scand 2022; 102:99-104. [PMID: 36324236 PMCID: PMC9780717 DOI: 10.1111/aogs.14477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/26/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Shoulder pain is one of the most common complications after laparoscopy. Previous studies have found a number of methods to reduce shoulder pain after laparoscopic surgery, but these methods have not been targeted to specific populations. The purpose of this study was to identify people who are more likely to develop shoulder pain. MATERIAL AND METHODS A total of 203 patients underwent laparoscopy for benign gynecological diseases between July 2020 and February 2021. Patients were divided into two groups according to the Chinese overweight standard, body mass index less than 24 kg/m2 group and 24 kg/m2 or more group. The baseline characteristics and intraoperative data between the two groups were compared. The intensity of the shoulder pain was quantified using a visual analog scale (VAS). RESULTS The incidence and the VAS scores of shoulder pain were significantly higher in the less than 24 kg/m2 group (63.64% vs 38.03%, p < 0.001 in incidence; median 5 (interquartile range [IQR] 3-7) vs 3 (IQR 2-5), p < 0.001 in VAS scores), and the chance of shoulder pain within 24 hours after laparoscopy was higher in the less than 24 kg/m2 group (89.29% vs 66.67%, p = 0.013). In univariate and multivariate logistic regression analysis, BMI less than 24 kg/m2 was an independent risk factor of shoulder pain after laparoscopic surgery (p = 0.001, p = 0.031, respectively). Shoulder pain scores were inversely correlated with BMI (r = -0.300, p = 0.001). CONCLUSIONS Patients with low body mass index are more likely to develop shoulder pain after laparoscopy, with earlier onset and higher pain scores.
Collapse
Affiliation(s)
- Yuxia Jiang
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Yijun Wu
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Shentao Lu
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
| | - Yuni Que
- Department of GynecologyPeople's Hospital of Shapingba DistrictChongqingChina
| | - Yugang Chi
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
| | - Qianfen Liu
- Department of Obstetrics and GynecologyChongqing Health Center for Women and Children (Women and Children's Hospital of Chongqing Medical University)ChongqingChina
| |
Collapse
|